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Tri-City Hospital Election Challenges Voters

Tri-City Hospital Election Challenges Voters


Alison St John, North County reporter, KPBS


Voters are hearing confusing and disturbing allegations from candidates running for the Tri-City Hospital board in North County.

Voters are faced with confusing messages from the candidates running for Tri-City's Medical Center board.

Tri-City Medical Center has served the North County coastal region around Oceanside, Carlsbad and Vista for 50 years. It’s one of North County’s largest employers with nearly 2,000 employees. Tri-City is a publicly-owned hospital that has evolved into a health-care district, with about 700 physicians and outpatient facilities.

Tri-City’s emergency room treated 65,000 people last year, and more than 2,500 babies were delivered at the hospital. Oceanside resident Brennon Walker‘s baby was one of them.

“One of my kids was born there,” he said. “They did a stand up job.”

But Walker said he hasn’t yet picked four candidates from the nine on his ballot to run Tri-City's board.

“No, I haven’t put much thought into that one,” he said. Walker added he would do some research now that it had been brought to his attention.

Voters who pay attention to what’s happening at their hospital may be disturbed:

Two CEO’s have been let go by the board in the last three years, both under mysterious circumstances and both with generous severance packages of more than $600,000. In 2009, the previous CEO left with a severance package of more than a $1 million. Lawsuits during the past year over Medicare billing and a new medical office building threaten to cost the district more than $20 million.

And there are other issues that have dogged Tri-City, including restraining orders to prevent previous board members from attending meetings.

Flyers with competing slates of candidates bear different messages.

The headline on one funded by SEIU, the union that represents the nurses at Tri-City, reads “Tri-City caught gaming the system." Another flyer, paid for by the North County Leadership Council reads, “The Future of Tri-City Hospital is Bright!”

Who is supporting the candidates?

Campaign contribution disclosures show campaigns for candidates Leigh Ann Grass and Marggie Castellano, plus incumbent Rosemarie Reno received $44,000 from SEIU.

The North County Leadership Council, an independent political action committee, has contributed $21,000 towards keeping incumbents Larry Schallock and Ramona Finnila on the board, and spent $7,000 to support Dan Hughes.

Hughes has also received $7,000 from the San Diego Republican Party and a Taxpayer Coalition.

Candidate Frank Gould raised about $4,000, Donna Rencsak raised $1,825 and Incumbent Julie Nygaard did not declare any contributions.

Competing messages

At a recent candidates’ forum shown on Oceanside’s cable channel, KOCT, one of the candidates running for the board, Frank Gould, sounded an alarm.

“I believe that Tri-City is for all practical purpose broke, to use the vernacular,” Gould said. “I believe the hospital could be on the path to doomsday if it continues with the incumbents we have guiding it — or misguiding it as they are doing now.”

But Ramona Finnila, one of the four incumbents who is hoping to keep her seat this year, disagreed.

“This is not true," she said. “We have had three years of a clean financial audit. I can tell you, based on my years of being here, that this hospital is solid financially. We’re going forward with a great plan."

Can voters make sense of it?

Carlsbad resident Julie Peterson is one voter who gave up trying to make sense of it all.

“I had no way of finding out anything about these people,” she said. "So I actually left it off — I didn’t even make a choice.”

Peterson thinks voters should not be asked to choose who runs their hospital.

“It should be something that is run by an organization, not the people,” she said.

Public vs. private

Many hospitals and health-care systems in San Diego, like Sharp and Scripps, are run by private nonprofits, rather than by publicly elected boards.

Health care consultant Nathan Kaufman said health care is getting so complex, it needs people with specialized knowledge to run the systems.

“When I work with physicians and represent them with hospitals, they hire me because even they don’t understand the business aspects of health care," Kaufman said. “The bottom line is, if you looks at the health care systems that are performing the best in San Diego, they are not the public health care systems."

Kaufman cites the Medicare cost reports from the American Hospital Directory that compare Tri-City with Scripps Mercy and Sharp Grossmont.

Scripps Mercy and Sharp Grossmont hospitals each have patient revenues and budgets twice the size of Tri-City. But their net incomes were $44 million and $51 million respectively last year, compared to Tri-City’s net income of $1.6 million.

Grossmont Hospital in La Mesa is also publicly owned. But in 1991 the hospital was leased to Sharp, a private nonprofit, whose management is appointed rather than elected. Since then, satisfied voters have doubled the length of the lease to 30 years.

Another publicly-run hospital in North County, Palomar Health, has managed to avoid some of the personnel issues and litigation that have plagued Tri-City. Palomar was able to convince voters in 2006 to approve a bond measure, which resulted in a brand new hospital that now towers over Escondido and meets required earthquake codes.

Tri-City has tried three times to convince voters to pass a bond to rebuild the hospital. It failed each time to get the needed two-thirds approval, most recently in 2008. Tri-City is currently applying to HUD for a loan to meet the requirement to make the hospital earthquake safe by 2030.

Kaufman questioned whether a publicly elected board could effectively steer the healthcare district through the financial hurdles ahead.

“The challenge you have at Tri-City is they have to rebuilt their facility in order to meet earthquake standards,” he said, ”and unfortunately their financial performance is such that it will be difficult for them to raise the money.“

Looking on the bright side

But the head of the San Diego’s Hospital Association, Dimitrios Alexious, has a more positive take on Tri City’s future, especially because of a recent partnership agreement the district has signed with UC San Diego.

“Health care organizations — when they are adding services, adding new equipment, affiliating with other organizations, partnering in the community — those aren’t tell tale signs of an organization who’s teetering on the brink of bankruptcy or financial distress,” Alexious said.

Oceanside resident Zac Beck is also optimistic. Beck, who is Oceanside’s city clerk, was happy to offer his opinion when asked during a chance meeting on his way to the gym. He admitted to being a well-informed voter, perhaps more than most.

“I do have a good idea of who I’m going to vote for,” he said.

Beck believes it’s a good thing his hospital is controlled by a publicly elected board.

“I think you’re going to receive some of the best services possible because the public officials elected to that board are accountable to the people who are receiving the healthcare services directly," he said. "I do believe that’s an important thing.”

Voter Brennon Walker summed things up this way.

“The way it works now, it works,” he said, “so until it doesn’t work, I think we’re alright.“

Whoever voters pick to run Tri-City will have to navigate with a steady hand to survive in the choppy waters of the changing health care system.

An earlier version of this story said ' most hospitals and health-care systems in San Diego, like Sharp and Scripps and UCSD are run by private nonprofits, rather than by publicly elected boards. UCSD is part of a public university system.


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